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The goal of treatment for nasal trauma is to identify fractures or septal
hematomas and to reduce the risk of cosmetic or functional deformity. Nasal
septal hematomas require emergent drainage, whereas bony fractures may require
delayed repair (5 to 7 days) for improved functional or cosmetic outcomes.
Detecting other injuries to the face associated with nasal injury including ocular,
orbit, facial bone, or sinus injury is the secondary goal of treatment as these
injuries may be life-threatening or have serious sequelae if not detected.
CLINICAL PEARLS AND PITFALLS
Approximately 1 in 5 nasal injuries presenting to the ED will have a
nasal fracture, with higher risk in younger children (i.e., less than 5
years old) and male gender.
Septal hematomas should be drained promptly to avoid necrosis of the
nasal cartilage resulting in perforations or external deformity.
A thorough assessment should be performed to avoid missing CSF
rhinorrhea secondary to an associated injury.

Current Evidence
The nose in children is composed of prominent soft cartilage, which dissipates the
force of impact across the midface. The bony components of the nose and septum
can be fractured or displaced during injury. Nasal fractures that extend to the
anterior skull base and cribriform plate can result in CSF rhinorrhea. Injuries to
the globe, as well as fractures of the orbit and paranasal sinuses can also occur
with nasal injuries. Facial fractures and midface injuries are covered in Chapter
107 Facial Trauma .

Clinical Considerations
Clinical Recognition
Injuries due to minor trauma or sports are commonly associated with nasal
fracture. Patients typically present with nosebleed, edema, or ecchymosis. Rarely,
the chief complaint will be clear rhinorrhea in the setting of recent trauma.
Triage

Children with nasal injuries are generally in mild or moderate discomfort on
presentation. Epistaxis should be addressed with application of direct pressure.
Nasal injury as part of major trauma or with associated neurologic changes
warrants emergent evaluation.